Wound healing

As the wound heals underneath your baby’s tongue it will turn a white/yellow colour. This is a normal part of wound healing. This will gradually disappear after a couple of weeks. If using bottles or teats ensure everything is sterilised appropriately prior to use. Infection after a frenulotomy is very rare, however if the wound looks red or inflamed and/or your baby seems unwell or has a high temperature then take your baby for an urgent medical assessment.

 

Unsettled baby

If your baby seems sore or more upset than usual then frequent feeds and lots of cuddles will help. If you baby is over 8 weeks old then they can have infant Calpol, according to the instructions on the bottle. If you baby is younger than 8 weeks then you need to speak with your GP first.

 

Exercises

You may have heard about wound massage to prevent reattachment. I do not advocate this as there is no evidence to support it in practice. However some gentle, fun exercises along with frequent feeds (2-3hrly) may help your baby’s tongue function. Start by poking your tongue out at your baby. Your baby may try and copy you!. The day after the procedure, with clean fingers, you may wish to:

• Put your finger, pad side up into your baby’s mouth to encourage sucking. Then play a gentle ‘tug of war’ game.
• Gently rub your baby’s bottom gum, side to side. Your baby’s tongue may follow your finger.
• When your baby is sleeping, gently press down on their chin. If their tongue is resting on the palate, this will give the wound a gentle stretch.

 

Reattachment of the wound

After a frenulotomy it is important to give your baby some time to heal and develop their feeding skills. Sometimes there is a deterioration in feeding in the first couple of weeks as the wound contracts and heals. For this reason it is sensible to wait at least 3-4 weeks before considering a re-division. According to available data, around 4% of babies will heal in a way that the wound reattaches and causes further restriction. It is not about how the frenulum was divided, but simply about how your baby has healed. If you experienced an initial improvement with feeding and feeding has again deteriorated then I am happy to review your baby again. This would be a follow up appointment.

 

Bleeding Guidance from the Association of Tongue Tie Practitioners

Although not common, there have been reported cases of bleeding which has occurred sometime after tongue-tie division, usually on the same day, when the babies have returned home. If this occurs the bleeding is usually very light and is triggered by strenuous crying ( resulting in the tongue lifting and disturbing the wound) or when the wound is disturbed during feeding, particularly if the wound is caught by a bottle teat or tip of a nipple shield.

• If you notice any blood in your baby’s mouth then offer the baby the breast or bottle and feed them. This will usually stop the bleeding within a few minutes just as it did immediately after the procedure. If the baby refuses to feed then sucking on a dummy/pacifier or your clean finger will have a similar effect.
• If the bleeding is very heavy or does not reduce with feeding and stop within 15 minutes, then apply pressure to the wound under the tongue with one finger using a clean piece of gauze or muslin for 10 minutes. Do not apply pressure under the baby’s chin as this can affect breathing.
• If bleeding continues after this time continue to apply pressure to the wound and take your baby to hospital (call an ambulance if you live more than a very short distance from the Accident and Emergency Department).